For many people, mobility changes can feel as though they simply “happen,” and that nothing can be done about them. In reality, mobility changes in multiple sclerosis (MS) are complex and multifaceted and there are actually many ways to influence how MS affects your ability to move.
Not All Mobility Challenges Are the Same
Mobility challenges generally fall into two categories:
Primary contributors — caused directly by MS, sometimes referred to as “First level symptoms”
Secondary contributors — develop over time as a result of primary issues, sometimes referred to as “Second level symptoms”
This distinction matters because different causes often require different solutions. While it may not always be possible to clearly identify whether a specific issue is primary or secondary, understanding the difference can help guide your approach as you explore ways to manage, adapt to, or improve these issues.
Primary Contributors: The Direct Effects of MS
MS can affect mobility in a variety of ways. It may cause muscle weakness, abnormal muscle tone, sensory changes, vision problems, balance difficulties, dizziness, and fatigue. These symptoms can make walking and other activities more difficult through reduced stability, increased effort, or issues such as foot drop that affect how your limbs function.
Even on their own, these challenges can significantly affect your ability to move through the world. However, they often lead to additional issues that, while not directly caused by MS, can further impact mobility.
Secondary Contributors: The Ripple Effect
Secondary contributors develop as a result of primary symptoms. You can think of this like ripples spreading outward after a rock is dropped into a pond. While the ripples are no longer directly connected to the rock, they still influence the surrounding water.
For example, a fall caused by muscle weakness or foot drop may lead to a fear of falling. This fear can reduce your activity level, which in turn leads to further physical deconditioning. Similarly, abnormal muscle tone in one leg may cause changes in how you walk, leading to strain or pain in other areas such as the hips or opposite leg. Fatigue may also reduce activity, contributing to decreased strength and endurance.
A Vicious Cycle
Mobility challenges can sometimes create a negative cycle: moving less leads to deconditioning, which in turn makes movement even more difficult. Over time, this cycle can expand beyond physical effects. Reduced mobility may limit social engagement, decrease independence, and lower overall quality of life.
But there is good news!
Interrupting the Cycle
There are many opportunities to break this cycle and maintain—or even improve—your mobility. Working with a neurologist and a physical therapist can help address both primary and secondary contributors.
The earlier you bring up your concerns and begin addressing them, the better your potential outcomes. Early intervention can reduce the risk of secondary complications, help preserve mobility, and support ongoing independence. Many secondary factors, such as deconditioning or stiffness, are highly preventable and often reversible.
Treatment Approaches: Primary Contributors
Understanding the underlying cause of a mobility issue can help determine the most effective treatment approach.
Muscle Weakness and Spasticity: Weak muscles make movement more difficult and less efficient. Abnormal muscle tone, such as tightness or spasticity, can limit range of motion and interfere with smooth, coordinated walking. Strategies such as strength training, stretching, and tone management can be beneficial. Assistive devices and certain medications may also play a role.
The key here is consistency and targeted effort.
Sensory and Visual Changes: Changes in sensation and vision can make it harder to detect where your feet are, increasing fall risk and reducing confidence. Vision issues may also contribute to dizziness and instability.
Many strategies to explore focus on compensation, including:
- Balance training to improve stability despite sensory changes
- Visual strategies to guide movement when sensation is reduced
- Environmental adjustments, such as improving lighting and reducing clutter
Assistive devices like canes or walking poles can provide added stability and feedback. Evaluation by a neuro-ophthalmologist may also help address visual symptoms. Many people see an improvement in their balance and confidence with targeted exercises.
Fatigue: Fatigue is one of the most common symptoms of MS and can act as both a primary and secondary contributor to mobility challenges. It may be physical, cognitive, or both.
Identifying the type and cause of fatigue is important, as different causes require different strategies. For example, cognitive fatigue from mental overload requires a different approach than physical fatigue caused by overheating.
Although it may seem counterintuitive, increasing activity can often help reduce fatigue over time by improving strength and endurance. Additional strategies include:
- Energy conservation techniques (pacing and prioritizing)
- Breaking up sedentary periods and mixing in movement or activities throughout the day
- Cooling strategies
- Using assistive devices to reduce effort
Because fatigue can reduce stamina, increase fall risk, and lead to decreased activity, it is important to address it proactively.
For more information about Fatigue, check out the Fall 2019 issue of InforMS: “Focusing on Fatigue.”
Treatment Approaches: Secondary Contributors
Secondary factors develop gradually, but they can often be modified or reversed when identified early.
Fear: Experiencing a fall or near-fall can understandably lead to a fear of falling. Rebuilding trust in your body is essential. This can be achieved through safe, controlled practice with balance and gait training. Start gradually. Avoid pushing yourself too far too quickly, but continue to challenge yourself when it is safe to do so. Assistive devices such as canes or walkers can provide support while you rebuild strength, stamina, and confidence. Over time, you may find that these tools allow you to remain more active and independent.
Consistently practicing movement and safely testing your limits can significantly improve both physical ability and self-assurance.
Compensation Patterns: When muscles are weak, the body often compensates by relying on other muscles or joints in unnatural ways. Over time, this can lead to strain, pain, or injury.
A physical therapist, especially one experienced in neurological conditions, can help identify and correct these patterns through gait training and alignment strategies. Orthotic devices may also provide support. These can be low-tech, such as an ankle-foot orthosis, or AFO, to higher tech, such as a functional electrical stimulation (FES) device. A PT can help you to understand the differences and give opinions on which might work best for your situation. In addition, strengthening targeted muscles can reduce the need for compensation in the first place.
Spasticity: Muscle tightness and joint stiffness can restrict movement, affecting both balance and walking ability. Regular, gentle movement is one of the most effective ways to manage these symptoms.
Helpful strategies include:
- Stretching throughout the day
- Practicing controlled, full-range joint movements
- Maintaining proper positioning when sitting, standing, and sleeping
Medications may also be an option, although they may have side effects such as drowsiness. Careful timing and adjustment may be needed to find the right balance.
For more information about the causes and treatments of Spasticity, check out the presentation “Symptom Management: Spasticity” by Dr. Robert Gross at the 2024 Spring Education Summit.
Deconditioning: When movement becomes difficult, it may feel natural to avoid it. But this can lead to further decline. Reduced activity over time can result in deconditioning, or the loss of strength and endurance. This often occurs after a relapse or illness. Even after recovery, rebuilding strength and stamina takes time.
It is important to start small after a period of prolonged inactivity. Choose manageable activities and gradually increase both duration and intensity as your tolerance improves. Focus on activities that are meaningful to you and consider supports that make movement easier. Deconditioning can be improved, but it will take the right strategy and consistency over time.
Adapting to Stay Active
There are many strategies that you can explore to maintain your ability to move with MS. Most of them require adapting tasks and activities to match your current abilities. While this may take patience, reflection, and creativity, these adjustments can help you continue doing the things you enjoy or need to do. Rather than resisting modifications, view them as tools that support your independence and quality of life.
For an in-depth look at this topic from Physical Therapist Mark Mañago, check out “Understanding and Addressing Mobility Challenges in MS” from the 2023 Fall Education Summit.
